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Between 5% and 15% of rhinoplasty patients want a second surgery, usually to correct breathing problems or nasal obstruction, nose tip asymmetry, or a crooked middle-third of the nose, according to a study of 104 patients seeking revision surgery. "These findings emphasize the importance of physician awareness of patients' concerns, understanding the causes of postsurgical nasal obstruction and clearly explaining nasal aesthetics to patients seeking revision rhinoplasty," the researchers said.

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People whose nose deviates from the center are also more likely than those with a straight nose to have an asymmetrical face, researchers report in JAMA Facial Plastic Surgery. Rhinoplasty patients with facial asymmetry are often unhappy with surgical results.

A baby boy born recently in Alabama has no nose, though he is breathing through his mouth, his mother said. Surgeons could construct a cosmetic nose now but would have to wait until after the boy is through puberty to construct functioning nasal passages and sinus cavities.

Most patients were highly satisfied with the results of nasal tip surgery involving completely dissecting and advancing the lateral crus, repositioning the dome and using alar strut grafts with medial extension, researchers report in the Archives of Facial Plastic Surgery. "We feel that the concept of nasal tip recontouring through the endonasal complete release approach is shown to generate naturally soft nasal tips and excellent cosmetic and functional results in the young female primary rhinoplasty patient population," the researchers write.

Rhinoplasty patient demographics are shifting, with ethnic minorities accounting for 29% of all cosmetic procedures in 2010, according to the American Society of Plastic Surgeons, and surgical techniques are evolving as well. Patients increasingly want to reshape their noses to fit their own faces, not to mimic a celebrity's nose, plastic surgeons say. "It was very cathartic for me, very poignant. ... It's a nose that finally fits my face," said a New York psychotherapist who cried when she saw the results of her rhinoplasty.